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Fluids and Electrolytes Quiz 1
1 / 10
A 30-year-old female in postpartum period develops AKI Work up shows Na-135 mEq/L, K-6.5 mEq/L and Cl-105 mEq/L and blood glucose of 120 mg/dl. What should be the next step in management?
(Ref: Harrison 21st ed, p 355; Harrison 20th ed, p 310-311) Since, potassium is dangerously elevated in this patient with AKI, priority medical intervention would be to start insulin drip to stabilize potassium values. A combination of IV insulin dose of 10 units plus 25 g of dextrose reliably lowers the serum potassium level by 1 mEq/L within 10-20 minutes and the effect lasts about 4-6 hours.
2 / 10
A 30-year-old man with weight of 70 kg is admitted due multiple episodes of seizures. He is sick for past 3 days and his family members inform that he was complaining of headache and recurrent falls. On work up, his Serum sodium = 120 mEq/L. Calculate the total sodium deficit.
3 / 10
A 30-year-old patient was behaving strangely and developed an episode of seizure on presentation to ER. On work up of patient urine osmolality = 1000 mOsm/Kg water and plasma osmolality 200 mOsm/Kg water. Which of the following is the most probable dyselectrolytemia present in this case?
4 / 10
A 60 kg female patient is sick for past one week was admitted with seizures. Work up shows serum Na= 120 mEq/L, S. Potassium = 4 mEq/L and Serum Chloride = 90 mEq/L. Calculate the correction to be done in these patients in the next 24 hours.
5 / 10
A 65-year-old male presented to casualty with protracted vomiting. On work up Hb- 5.4 gm%, Urea - 83 mg/dL, S. Creatinine = 2 mg/dL, uric acid - 8 mg/dL, Ca - 12 mg/ dL, K =- 4.4 mEq/dL. On bone marrow aspiration there are 60% of plasma cells. What should be the next line of management?
(Ref: Harrison 21st ed, p 357; Harrison 20th ed, p 2935) The patient with multiple myeloma is having mild Hypercalcemia with deranged KFT. The presence of vomiting explains the deranged KFT and hypokalemia. Medical therapy should be used in the patient initially. This would involve forced diuresis using IVF and Furosemide.
6 / 10
A 65-year-old male presented to casualty with swelling all over the body and no urination reported for last 24 hours. On work up Hb- 5.4 gm%, Urea - 83 mg/dL, S. Creatinine = 6 mg/dL, uric acid = 8 mg/dL, S. Calcium = 14 mg/dL, K=- 6.4 mEq/dL. On bone marrow aspiration there are 60% of plasma cells. What shall be the next line of management?
(Ref: Harrison 21st ed, p 357; Harrison 20th ed, p 2935) The patient is having severe hypercalcemia (range = 13-15 mg/dl) with deranged KFT and volume expansion. Even potassium is dangerously elevated. Dialysis is recommended in life-threatening hypercalcemia that is complicated by renal failure and is difficult to manage medically. Option b is treatment of Multiple myeloma and can wait while we stabilize the patient. So, option b is ruled out. Option c involves forced diuresis with IVF and furosemide. It will worsen volume overload of patient who is in renal failure and in setting of severe hypercalcemia plus. Hyperkalemia would be a risky proposition. Option d is ruled out as IV bisphosphonates are used in severe Hypercalcemia in renal failure plus would need dose adjustment as they are excreted via kidney.
7 / 10
A female patient with hysteria was hyperventilating. She subsequently developed carpopedal spasm. On work-up ABG value of pH = 7.53, pCO2 = 20 mm Hg, HCO3 = 26 mEq/L is seen. The clinical diagnosis is:
(Ref: Harrison 21st ed, p 368; Harrison 20th ed, p 324) Hyperventilation leads to carbon dioxide washout and respiratory alkalosis. pH is elevated and CO2 is low points to respiratory etiology and alkalosis. Bicarbonate is normal indicating compensation has not started. Both metabolic and respiratory alkalosis after levels of ionized calcium and can trigger carpopedal spasm.
8 / 10
ABG report of patient shows pH = 7, pCO₂ = 30 mm Hg and bicarbonate levels 10 mEq. What is the acid base = abnormality?
(Ref: Harrison 21st ed, p 364; Harrison 20th ed, p 315) Since, pH is less and HCO, is less, it implies metabolic acidosis Now, for compensation PCO₂ = HCO3 + 15 = 10 + 15 + 25 mm Hg The predicted value is not matching with actual value of PCO2 = 30 mm Hg. This implies compensation is not there and it is a mixed disorder. Conclusion: metabolic acidosis with respiratory acidosis.
9 / 10
A laborer fainted while working on a construction site on a hot sunny day. His skin turgor is reduced with a body temperature of 105°F. Which is the least likely to be seen in this patient?
10 / 10
In a patient who was brought to casualty after RTA with pulse rate 108, SBP 80. Which fluid is to be given ideally?
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IIT JAM 2015 PREVIOUS YEAR PAPER
